{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Cynthia J Sargent","gend":1,"currentgend":"","add":"103 READ ST","city":"PORTLAND","state":"ME","zip":"04103","dob":"1948-08-05","age":"","mstatus":"","insh":"10000057563","cliId":"","pno":2075189216,"cno":"","email":"snancindy48@aol.com","ename":"","eno":"","pphy":"CHAPPELLE, CATHRA M","ppno":2078282402,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"103 READ ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078282425,"pcpnpi":1912957069,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7FX3GR6EC80","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K529","C9200","Z5111","U071","I420","R6510","D709","K810","D469","R509","R197","D509","Z95810","Z452","K219","R634","M542","M47812","M25561","M1711","R531","Z87891","D7589","S0990XA","C9201","R519","M5136","J9811","D708","I10","E860","L03011","Z8719","R110","R1010","Z9049","R609","D701","Z13228","Z13220","D703","R6883","R21","D729","D649","E8342","I340","J069","R5081","I428","R1111","Z23","S22080A","R059","K449","R935","S3992XA","R079","I509","I447","I493","Z950","Z95828","C946","I071","D72819","B370","B338","D61818","D704"],"date":["2025-03-17","2025-10-08","2025-01-31","2025-03-05","2025-07-11","2023-01-03","2025-07-25","2023-08-15","2025-07-25","2025-09-23","2025-03-31","2025-08-25","2025-10-09","2024-03-15","2025-08-25","2025-05-30","2024-04-26","2024-04-26","2024-04-26","2024-04-26","2025-03-17","2025-03-17","2024-04-15","2024-04-26","2024-03-22","2024-04-26","2022-11-28","2022-11-28","2024-03-07","2024-03-11","2025-03-22","2024-09-02","2025-07-25","2025-03-24","2025-03-17","2025-03-17","2025-03-17","2025-02-25","2023-03-20","2023-03-20","2025-09-23","2025-09-23","2024-01-19","2024-01-19","2024-04-15","2025-03-19","2023-12-15","2024-02-26","2023-11-29","2024-06-18","2023-01-01","2024-11-04","2022-11-28","2024-01-28","2025-02-25","2025-02-25","2022-11-28","2023-11-26","2024-03-11","2023-12-19","2023-12-19","2023-12-19","2024-11-19","2024-03-01","2024-12-13","2023-11-29","2024-04-15","2023-11-29","2022-09-26","2022-09-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","VENCLEXTA","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LACTULOSE","","","Select","Select",""],["","","POSACONAZOLE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}